Mary Dolores Mancillas-Loveless, PTA, LMT, C.PED

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1096 Issued in MT

Practice address

612 1St Ave. So.
Great Falls, MT 59401

Phone

(406) 750-2655

NPI assigned

Sep 9, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315526400000",
    "number": "1952683542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3026 4TH AVENUE SOUTH",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594053330",
            "telephone_number": "406-750-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 1ST AVE. SO.",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "59401",
            "telephone_number": "406-750-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCILLAS-LOVELESS",
        "first_name": "MARY",
        "middle_name": "DOLORES",
        "credential": "PTA, LMT, C.PED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-09",
        "last_updated": "2011-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MT",
            "license": "1096",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MT",
            "license": "568",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Great Falls, MT
• Providers in Great Falls, MT by specialty
• Physical Therapy Assistant in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.